Parkinson’s Disease
A progressive condition of movement — but one where the right treatment, chosen at the right stage, can return years of independence.
Treatment
Medication Management
Before anyone discusses surgery, the medication has to be right. A surprising number of patients arrive with symptoms that are not resistant to treatment — only under-treated.
Why medication review comes first
Medication management means matching the drug, the dose and — often most importantly — the timing to the individual patient, and revising it as the condition changes.
It is not a formality before the interesting part. A significant proportion of patients who come to us convinced they need surgery turn out to be taking levodopa at intervals that guarantee "off" periods, or an adjunct drug that is producing side effects mistaken for disease progression. Correcting that is faster, cheaper and safer than an operation.
Equally, an honest medication review is what makes a surgical assessment meaningful. "Medication-resistant" only means something if the medication was optimised in the first place.
What the review covers
- The diagnosis itself — is this Parkinson’s disease, or an atypical parkinsonism that will not respond the same way?
- Levodopa dose and, critically, dose interval relative to when symptoms return
- Adjunct medication: dopamine agonists, MAO-B inhibitors, COMT inhibitors, amantadine
- Drugs that may be causing or worsening tremor — some antidepressants, lithium, valproate, bronchodilators
- Non-motor symptoms: sleep, mood, blood pressure on standing, constipation
- Protein and meal timing, which affects levodopa absorption more than most patients are told
How we work
Adjustments are made in stages, not all at once, so that the effect of each change can be attributed. We ask patients to keep a simple diary — when the dose was taken, when it started working, when it wore off — because that record is worth more than any single clinic observation.
For international patients this can begin remotely, before travel, and continue after you return home in coordination with your own neurologist. In many cases a video consultation and a two-week diary answer the question of whether a flight to Istanbul is warranted at all.
Medication after DBS
Deep brain stimulation does not end medication — it usually allows a substantial reduction. The two are adjusted together during the programming period, and getting that balance right is a large part of why we ask DBS patients to stay three to four weeks rather than one.
Reducing dopaminergic medication too quickly can cause its own problems, including low mood and apathy. This is managed deliberately, not left to chance.
Conditions treated
Frequently asked questions
Can my medication be reviewed without travelling to Istanbul?
Yes. Send your current medication list, recent neurologist reports and a short symptom diary, and the initial review can be done by video consultation.
Will I be able to stop medication after surgery?
Usually not entirely. Most DBS patients reduce their daily dose significantly, but medication continues in some form. Anyone promising a complete stop is overstating what the procedure does.
Does food really affect levodopa?
Yes. Levodopa competes with dietary protein for absorption, so a dose taken with a protein-rich meal can work late or barely at all. Adjusting timing around meals is often one of the simplest and most effective changes we make.
Not sure where to start?
Send us your reports and a short note. A coordinator replies within one working day — no cost, no obligation.